A Pain in the Foot

Mary Ann Joyce had just finished playing a round of golf last March when she felt a sharp pain in her left heel. “I didn’t feel it on the course, but as soon as I changed shoes afterward, it was there,” says Joyce, now 68. The Frankfort, Ill., resident, who was vacationing in Florida at the time, immediately made a podiatrist appointment. The diagnosis: plantar fasciitis.

An inflammatory condition of the tissue on the bottom of the foot, plantar fasciitis (pronounced fash-ee-EYE-tus) is the most common cause of heel pain, affecting about 2 million Americans every year. It can be difficult to treat, but it is almost always curable through conservative measures.

“Ninety-nine percent of the time, you can resolve symptoms through nonoperative treatments,” says Keith Wapner, MD, clinical professor of orthopedic surgery at the University of Pennsylvania. For Joyce, six weeks wearing an immobilizing orthotic boot, followed by physical therapy to stretch and strengthen the muscles of her calves and feet, did the trick. Her symptoms disappeared in three months.

Here’s how to tell if you’re at risk for plantar fasciitis, along with some tips for prevention and treatment.

When Plantar Fasciitis Strikes

The plantar fascia is a thick, flat band of connective tissue that spans the sole of the foot, connecting the heel bone to the toes and supporting the arch. The exact cause of plantar fasciitis is unknown, but most experts believe excessive tension or stress creates small tears in the tissue, which then becomes inflamed.

The hallmark symptom, sharp heel pain, usually starts with the first steps in the morning or when standing after periods of rest. “As plantar fasciitis progresses, you still have startup pain, but it hurts more often,” Wapner says. “Eventually, it hurts all the time.”

Anyone can develop plantar fasciitis, but the following factors increase your risk:

Tight calf muscles: When your calf is tight, it pulls on your Achilles’ tendon and creates tension on the plantar fascia.

Improper footwear: Shoes that are overly flexible at the arch can increase pressure on the plantar fascia. Calf-tightening high heels also contribute to the problem.

Overtraining or a rapid increase in mileage: Increasing mileage by more than 10 percent per week can make runners more prone to developing plantar fasciitis.

Faulty biomechanics: “Overpronation [landing on the outside of your foot and rolling in] causes a lot of tension when the heels and toes lift off the ground,” says Stephen Pribut, DPM, a Washington, D.C., podiatrist and past president of the American Academy of Podiatric Sports Medicine. Movement problems at the hip or trunk can also lead to compensation patterns.

Excess weight: Studies have found that overweight people were more likely to develop plantar fasciitis because of added stress to the tissue and joints.

Heel-ing Powers

As with most overuse injuries, you can’t expect to resolve plantar fasciitis overnight. Seek treatment as soon as you feel heel pain — a medical professional can formulate a treatment plan incorporating the following strategies:

• Stretch it out. “The basic tenet of treatment is increasing flexibility in both the gastrocnemius, which is the large calf muscle that forms the Achilles’ tendon, and the plantar fascia itself,” says Wapner. (See “Foot Fixes,” below, for suggestions.)
• Upgrade your footwear. Avoid high heels and flip-flops, and wear supportive shoes even around the house. Some patients find relief in orthotics, which support the arch and distribute pressure in flat feet or high arches.
• Try massage. Myofascial techniques can soften tough, inflexible tissue and increase blood flow, Marcus says. Try rolling your foot over a tennis ball. (Start gently!)
• Wear a night splint. “A splint keeps your foot dorsiflexed so you don’t spend eight hours reversing the stretching you’ve done,” says Wapner. Two studies published in Foot & Ankle International found night splints had an 80 percent success rate in reducing plantar fasciitis symptoms.
• Apply ice. Icing the plantar fascia helps soothe pain and reduce inflammation. For a DIY ice massage, roll your foot over a frozen water bottle or use an ice-filled paper cup.
• Strengthen your feet. Some experts believe you can strengthen the muscles on the bottoms of your feet to take the pressure off the plantar fascia.

“For severe cases, your doctor might recommend a corticosteroid injection to help reduce pain and inflammation, though the injection can make the plantar fascia a bit more prone to rupture,” says Edward Laskowski, MD, codirector of the Mayo Clinic Sports Medicine Center in Rochester, Minn. And there is a surgical option that cuts the plantar fascia from the heel bone, though this is rarely performed, and experts advise at least a year of noninvasive therapy before even considering that route, which can lead to further complications.

Make an Active Recovery

You can continue to exercise with plantar fasciitis, but Laskowski suggests that you avoid sports that involve heavy pounding and replace them with low-impact activities such as swimming or riding a stationary bike. Runners who find it unrealistic to abandon their sport can try reducing mileage, provided their gait is not affected.

But the rule is, if it hurts, don’t do it. “If you keep going when you feel pain, it’s going to get worse,” says Curt Marcus, PT, DPT, the Chicago-area physical therapist who treated Mary Ann Joyce. Listen to your body and follow a treatment plan consistently. And be patient: About 90 percent of plantar fasciitis cases resolve within two months, so your chances of getting better are excellent.